After 9/11 and the subsequent anthrax attacks, the frightening possibility that enemies could wage a “biological war” on the U.S. became real, and led to astounding changes in the nation’s public health system. Many health agencies had been thrown into disarray after being targeted for massive budget cuts in the ‘80s, when their success in preventing common diseases rendered their high staff numbers “unnecessary,” and the effects were still evident in the Institute of Medicine’s grim prognosis for the efficiency of the public health system in 2002. But increasing concerns about national security that year led to agreements between the CDC, the Health Resources and Services Administration, states, territories, and a few big cities over the introduction of new health infrastructure. State and local health systems received a billion dollars annually to improve their ability to respond to nation emergencies through “preparedness” programs, while health officials joined first responders like firefighters and police officers in rescues. The NIH got research funds to study and develop defensive vaccines, while the U.S. Department of Homeland security developed a network of sensors within EPA filters designed to detect and assess dangerous particles. It seems clear that progress toward an America safe from biowarfare has been made, but recent disasters have revealed that problems with the way public agencies respond to emergencies remain. The U.S. response to the H1N1 epidemic showed that American scientists could quickly develop vaccines to combat the disease, but demonstrated the difficulty of quick vaccine distribution and the relative inefficiency of America’s outdated, egg-based procedure of vaccine production. Hurricane Katrina’s devastation was amplified by slow decision-making and confusion over the responsibilities of various government agencies, while the surge of injured people challenged hospitals and health care providers along the stricken coast. The 2010 Deepwater Horizon oil spill provided economic challenges to those who had managed to partially rebuild their lives after Katrina, reminding us of the need to involve public health agencies early in any large-scale crisis. Have we learned our lesson from the anthrax attacks and instituted substantive safety measures since then? Or have our recent emergencies shown that we haven’t changed quickly enough?
Jeanne Ringel, director of the Public Health Systems & Preparedness Initiative and a senior economist at RAND Health